RN exams clinical judgment practice questions, set 34
RN exams · clinical judgment
RN exams clinical judgment practice questionsset 34
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Five clinical judgment questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
Which primary prevention strategy will the nurse include in a community program on the prevention of hepatitis C?
A. Advising individuals with risky sexual behaviors to be screened for hepatitis C
B. Stressing that handwashing is important after changing diapers or using the bathroom
C. Recommending immunizations against the other viral hepatitis infections
D. Instructing individuals to avoid sharing needles, syringes, or other equipment contaminated with blood
Show answer and rationale
Correct answer: D — Instructing individuals to avoid sharing needles, syringes, or other equipment contaminated with blood
The correct answer is D because sharing needles or other equipment contaminated with blood is a significant risk factor for contracting hepatitis C. By instructing individuals to avoid sharing such equipment, the nurse is targeting a key mode of transmission for the virus. This primary prevention strategy directly addresses the root cause of hepatitis C transmission in high-risk populations.
Choice A is incorrect because while screening for hepatitis C is important, it is not a primary prevention strategy. Choice B is incorrect as handwashing is essential for preventing the spread of infections like hepatitis A and E, not hepatitis C. Choice C is incorrect because immunizations against other viral hepatitis infections do not protect against hepatitis C specifically.
In summary, advising individuals to avoid sharing needles or equipment contaminated with blood is the most effective primary prevention strategy for hepatitis C compared to the other choices provided.
Question 2
A patient with long-standing type 1 diabetes presents to the emergency department with a loss of consciousness and seizure activity. The patient has a history of renal insufficiency, gastroparesis, and peripheral diabetic neuropathy. Emergency personnel reported a blood glucose of 32 mg/dL on scene. When providing discharge teaching for this patient and family, the nurse instructs on the need to do which of the following? (Select all that apply.)
A. Administer glucagon 1 mg intramuscularly any time the blood glucose is less than 70 mg/dL.
B. Administer 15 grams of carbohydrate orally for severe episodes of hypoglycemia.
C. Discontinue the insulin pump by removing the infusion set catheter.
D. Increase home blood glucose monitoring and report patterns of hypoglycemia to the provider.
Show answer and rationale
Correct answer: B — Administer 15 grams of carbohydrate orally for severe episodes of hypoglycemia.
The correct answer is B: Administer 15 grams of carbohydrate orally for severe episodes of hypoglycemia. In this scenario, the patient is experiencing severe hypoglycemia (blood glucose of 32 mg/dL) leading to loss of consciousness and seizure activity. Administering 15 grams of carbohydrate orally is crucial to rapidly raise the blood glucose levels and address the hypoglycemia. This immediate intervention can help reverse the symptoms and prevent further complications.
The incorrect choices:
A: Administering glucagon intramuscularly is typically reserved for severe hypoglycemia when the patient cannot take anything by mouth. In this case, oral intake is preferred for faster absorption.
C: Discontinuing the insulin pump is not necessary in this situation since the primary concern is treating the acute hypoglycemia. Removing the infusion set can lead to hyperglycemia if not managed properly.
D: Increasing home blood glucose monitoring and reporting patterns of hyp
Question 3
The following has been found to act as a male contraceptive without affecting libido or potency:
A. Cyproterone acetate
B. Goserelin
C. Centchroman
D. Gossypol
Show answer and rationale
Correct answer: C — Centchroman
Rationale for Correct Answer C (Centchroman):
1. Centchroman is a non-hormonal male contraceptive that acts by inhibiting sperm production without affecting libido or potency.
2. It is a selective estrogen receptor modulator, which helps in contraception without affecting male sexual function.
3. Centchroman's mechanism of action does not interfere with testosterone levels or sexual desire, making it an effective male contraceptive option.
4. Studies have shown that centchroman is safe and well-tolerated, making it a suitable choice for male contraception.
Summary of Incorrect Choices:
A. Cyproterone acetate: It is a hormonal contraceptive that can affect libido and potency due to its anti-androgenic properties.
B. Goserelin: It is a hormonal drug that suppresses testosterone production, potentially affecting libido and potency.
D. Gossypol: It is a plant-derived compound that can impact sperm production and fertility without preserving libido and potency.
Question 4
When preparing a dental plaque smear and staining it according to the gram method, a student during microscopy detected there various violet and pink microorganisms. What structural component of microorganisms causes different response to stains?
A. Cell wall
B. Cytoplasm
C. Cytoplasmic membrane
D. Outer membrane
Show answer and rationale
Correct answer: A — Cell wall
The correct answer is A: Cell wall. In the Gram staining method, the primary differentiation of bacteria is based on the composition of their cell walls. Gram-positive bacteria have a thick layer of peptidoglycan in their cell walls, which retains the crystal violet dye and appears purple under the microscope. On the other hand, Gram-negative bacteria have a thinner layer of peptidoglycan and an outer membrane, which allows the crystal violet dye to be washed out during the decolorization step and take up the counterstain safranin, appearing pink. The different responses to stains are primarily due to the structural differences in the cell walls of these two types of bacteria.
Summary:
- Choice A: Cell wall is correct because it determines the differential staining in Gram staining.
- Choice B: Cytoplasm is incorrect as it does not directly influence the staining properties of bacteria.
- Choice C: Cytoplasmic membrane is incorrect as it is not the main structural
Question 5
Which of the following dilemmas involve the ethical principle of fidelity? Select all that apply.
A. When the nurse is unable to agree with the policies or common practices of an agency
B. When the nurse is faced with a decision to violate a policy that is harmful to the client
C. When the nurse is certain that clients of different racial and ethnic backgrounds are being treated the same as other clients
D. When the nurse understands that a combative client must be secluded against their will to prevent harm to others
Show answer and rationale
Correct answer: A — When the nurse is unable to agree with the policies or common practices of an agency
When the nurse is unable to agree with the policies or common practices of an agency, the nurse is facing a dilemma about fidelity, which refers to the obligation to honor commitments and contracts. When the nurse is faced with a decision to violate a policy that is harmful to the client, the nurse is facing a dilemma about fidelity—that is, should the nurse be faithful to the employing agency or the individual client being cared for. When the nurse is certain that clients of different racial and ethnic backgrounds are being treated the same as other clients, the nurse is acting in accord with the ethical principle of justice. When the nurse understands that a combative client must be secluded against his or her will to prevent harm to others, the nurse is following the ethical principle of utilitarianism. When a client refuses to take medications and the nurse respects the client's right to refuse medication, the nurse is enacting the ethical principle of autonomy.
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Question 6
A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan?
A. Environmental justice
B. Environmental epidemiology
C. Tertiary prevention
D. Risk communication
Correct answer:
The correct answer is A: Environmental justice. Environmental justice is the principle that all individuals, regardless of race or socioeconomic status, have the right to equal protection from environmental risks. In this scenario, the nurse would oppose the city dump near a poor and predominantly African-American community because it violates the principle of environmental justice by disproportionately exposing this community to environmental hazards.
Summary of incorrect choices:
B: Environmental epidemiology focuses on studying the distribution and determinants of diseases in populations, not on environmental justice principles.
C: Tertiary prevention involves managing and treating complications of existing diseases, not related to opposing unjust environmental decisions.
D: Risk communication involves effectively communicating risks and hazards to the public, which is not directly related to opposing unjust environmental actions based on principles of justice.
Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse?
A. Use and side effects of isoniazid
B. Standard four-drug therapy for TB
C. Need for annual repeat TB skin testing
D. Reasons for annual sputum cytology testing
Correct answer:
The correct answer is B: Standard four-drug therapy for TB. In this scenario, the nurse has a positive TB skin test but no symptoms or chest x-ray findings. This suggests latent TB infection. The standard treatment for latent TB infection is a four-drug therapy regimen to prevent the progression to active TB. It is essential for the occupational health nurse to educate the staff nurse about this treatment to prevent the development of active TB disease.
Choice A (Use and side effects of isoniazid) is incorrect because while isoniazid is part of the treatment regimen for latent TB infection, the nurse needs to be educated about the full four-drug therapy regimen, not just one drug.
Choice C (Need for annual repeat TB skin testing) is incorrect as the positive TB skin test already indicates latent TB infection, so repeat skin testing annually is not necessary.
Choice D (Reasons for annual sputum cytology testing) is incorrect because sputum cytology testing is not
The home health nurse cares for a patient who is diagnosed with chronic obstructive pulmonary disease. Which response(s) and behavior(s) by the nurse would indicate that bonding between nurse and patient has occurred? (Select all that apply)
A. Expects the patient to meet the goals for exercise as determined by the nurse.
B. Listens to the patient describe the feelings of anxiety related to severe dyspnea.
C. Develops teaching plan based on the learning preferences of the patient.
D. Refrains from touching the patient unless performing physical assessment techniques.
Correct answer:
The correct answer is B because actively listening to the patient describe their feelings of anxiety related to severe dyspnea demonstrates empathy and a deeper connection between the nurse and patient. This behavior shows understanding and support, fostering trust and rapport. It indicates that the nurse is attentive to the patient's emotional needs, which is essential for effective care in chronic conditions like COPD.
Option A is incorrect because expecting the patient to meet exercise goals set by the nurse does not necessarily indicate bonding. It may reflect a more authoritative approach rather than a collaborative relationship. Option C, while important for individualized education, does not specifically indicate bonding unless it involves understanding the patient's preferences on a personal level. Option D is incorrect because refraining from touching the patient may be necessary in some situations, but it does not directly relate to establishing a bond.
Why is milk produced only after delivery, not before?
A. Levels of luteinizing hormone and follicle-stimulating hormone are too low during pregnancy to support milk production
B. High levels of progesterone and estrogen during pregnancy suppress milk production
C. The alveolar cells of the breast do not reach maturity until after delivery
D. High levels of oxytocin are required for milk production to begin, and oxytocin is not secreted until the baby stimulates the nipple
Correct answer:
Correct Answer: B - High levels of progesterone and estrogen during pregnancy suppress milk production.
Rationale:
1. Progesterone and estrogen levels are high during pregnancy to maintain the uterine lining and support fetal development.
2. These hormones inhibit the action of prolactin, the hormone responsible for milk production.
3. As a result, the mammary glands are prevented from producing milk until after delivery when progesterone and estrogen levels drop.
4. Once these hormone levels decrease, prolactin can initiate milk production in response to the baby's demand for feeding.
Summary of other choices:
A: Levels of luteinizing hormone and follicle-stimulating hormone do not directly impact milk production during pregnancy.
C: Alveolar cells of the breast may have some developmental changes during pregnancy, but it is not the primary reason for milk production post-delivery.
D: Oxytocin is involved in milk ejection, not milk production, and its release is
After a change-of-shift report on a ventilator weaning unit, which patient should the nurse assess first?
A. Patient who failed a spontaneous breathing trial and has been placed in rest mode on the ventilator.
B. Patient who is intubated and has continuous partial pressure end-tidal CO2 (PETCO2) monitoring.
C. Patient with central venous oxygen saturation (ScvO2) of 69% while on bilevel positive airway pressure (BiPAP).
D. Patient who was successfully weaned and extubated 4 hours ago and now has no urine output for the last 6 hours.
Correct answer:
The correct answer is D - Patient who was successfully weaned and extubated 4 hours ago and now has no urine output for the last 6 hours. This patient should be assessed first because the absence of urine output for 6 hours after being extubated could indicate acute kidney injury or other serious complications that need immediate attention. Urine output is a crucial indicator of renal function and can reflect the patient's overall hemodynamic status. In contrast, the other choices do not present immediate life-threatening conditions. Choice A involves a patient in rest mode post-failed breathing trial, which does not require immediate assessment. Choice B mentions continuous PETCO2 monitoring, which is important but not as urgent as assessing a patient with no urine output. Choice C describes a patient with a ScvO2 of 69%, which may need monitoring but does not indicate an urgent priority compared to assessing a patient with no urine output after recent extubation.
After multiple attempts to stop drinking, an adult male is admitted to the medical intensive care unit (MICU) with delirium tremens. He is tachycardic, diaphoretic, restless, and disoriented. Which finding indicates a life-threatening condition?
A. Widening QRS complexes and flat T waves
B. Tachycardia and elevated blood pressure
C. Restlessness and anxiety
D. Diaphoresis and dehydration
Correct answer:
The correct answer is A: Widening QRS complexes and flat T waves. In the context of an adult male with delirium tremens and symptoms like tachycardia, diaphoresis, restlessness, and disorientation, the presence of widening QRS complexes and flat T waves on an ECG suggests severe electrolyte imbalance, particularly hypokalemia. This severe electrolyte imbalance can lead to life-threatening arrhythmias such as ventricular tachycardia or fibrillation. Tachycardia and elevated blood pressure (choice B) can be expected in delirium tremens but do not directly indicate a life-threatening condition as widening QRS complexes and flat T waves do. Restlessness and anxiety (choice C) are common symptoms of delirium tremens but do not specifically signify a life-threatening condition. Diaphoresis and dehydration (choice D) are also common in delirium tremens but do not directly point towards a life-threatening electrolyte imbalance as widening QRS complexes and flat T waves do.
The PRIORITY action to take when nursing a neonate on phototherapy is to
A. Turn the neonate every six hours routinely
B. Encourage mother to discontinue breastfeeding
C. Notify physician if the skin turns bronze-colored
D. Check the neonate’s vital signs every 2-4 hourly
Correct answer:
The correct answer is D: Check the neonate’s vital signs every 2-4 hourly. This is the priority action because neonates undergoing phototherapy are at risk for dehydration and temperature instability. Monitoring vital signs regularly helps to detect any signs of dehydration, such as decreased urine output or increased heart rate, and ensures timely intervention.
Explanation for other choices:
A: Turning the neonate every six hours routinely is important for preventing pressure ulcers but is not the priority when compared to monitoring vital signs for potential complications.
B: Encouraging the mother to discontinue breastfeeding is incorrect as breastmilk provides essential nutrients and hydration, which are important for neonates, even during phototherapy.
C: Notifying the physician if the skin turns bronze-colored is important to address a potential adverse reaction to phototherapy but does not take precedence over monitoring vital signs for immediate concerns.
What information does the nurse include when teaching parents about nonpharmacologic strategies for pain management in children?
A. May reduce pain perception.
B. Make pharmacologic strategies unnecessary.
C. Usually take too long to implement.
D. Trick children into believing they do not have pain.
Correct answer:
The correct answer is A: 'May reduce pain perception.' When teaching parents about nonpharmacologic strategies for pain management in children, the nurse should include information that these techniques may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. It is important to note that nonpharmacologic techniques should be learned before the pain occurs, and it is beneficial to use both pharmacologic and nonpharmacologic measures for pain control. Choice B is incorrect because nonpharmacologic strategies do not make pharmacologic strategies unnecessary but rather complement them. Choice C is incorrect as nonpharmacologic techniques, when properly learned and applied, do not usually take too long to implement. Choice D is incorrect as the goal of nonpharmacologic strategies is not to trick children into believing they do not have pain, but to help them cope with and manage their pain effectively.
Which of the following is a normal age-related change for the female reproductive system?
A. Lung capability increases.
B. The response to vaccines decreases.
C. The amount of calcium in the body increases.
D. Vaginal walls become drier and thinner.
Correct answer:
The correct answer is D: Vaginal walls become drier and thinner. This is a normal age-related change in the female reproductive system due to decreasing levels of estrogen during menopause. Estrogen helps maintain the thickness and moisture of vaginal walls. As estrogen levels decline with age, the vaginal walls can become drier and thinner, leading to symptoms like vaginal dryness and increased risk of infection.
A, B, and C are incorrect:
A: Lung capability increasing is not a normal age-related change for the female reproductive system. It is more related to factors like physical fitness and environmental exposures.
B: Decreased response to vaccines is not a direct age-related change in the female reproductive system. It is influenced by factors like immune function and overall health.
C: The amount of calcium in the body increasing is not a normal age-related change for the female reproductive system. It is more related to bone health and hormonal regulation.
A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the physician explained to the patient that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called?
A. Internal beam radiation
B. Trachelectomy
C. Brachytherapy
D. External radiation
Correct answer:
The correct answer is C: Brachytherapy. Brachytherapy involves placing a radiation source near or directly into the tumor site. In this case, after the hysterectomy, the source of radiation is placed near the cervical cancer site to deliver targeted radiation therapy. This method helps reduce the risk of cancer recurrence by delivering high doses of radiation to the tumor while minimizing exposure to surrounding healthy tissues.
Choice A (Internal beam radiation) typically refers to a type of external radiation therapy where radiation beams are directed at the tumor from outside the body, not placed internally like brachytherapy.
Choice B (Trachelectomy) is a surgical procedure that involves removal of the cervix while preserving the uterus, not related to radiation therapy.
Choice D (External radiation) involves delivering radiation from outside the body using a machine, unlike brachytherapy where the radiation source is placed internally near the tumor site.
RN exams clinical judgment practice questions, set 34 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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